Curriculum Intervention Research Articles

Assessment of the knowledge, attitudes and perceived quality of education about antimicrobial use and resistance of medical students in Zambia, Southern Africa.

Antimicrobial resistance (AMR) is a major global health threat, particularity in lower-middle-income countries (LMICs) where antibiotics are readily available, leading to antibiotic misuse. Educational interventions are lacking in Zambia. Our study assessed antimicrobial use and resistance knowledge, attitude and perceived quality of education relating to AMR in Zambian medical schools. A cross-sectional anonymous survey of students at six accredited medical schools in Zambia using a self-administered questionnaire was administered, using Qualtrics. Chi-squared, Fisher exact test, Pearson correlation test and Student's t-tests were performed for descriptive analyses. Multivariable logistic regression was used to examine associations between knowledge and antibiotic use, beliefs and behaviours. Analysis was performed in SAS version 9.4. One hundred and eighty responses from six medical schools were included in the final analysis. Fifty-six percent of students rated their overall education on antibiotic use as useful or very useful. Ninety-one percent thought that antibiotics are overused, and 88% thought resistance was a problem in Zambia. Only 47% felt adequately trained on antibiotic prescribing, and 43% felt confident in choosing the correct antibiotic for specific infections. Only 2% felt prepared interpreting antibiograms, 3% were trained to de-escalate to narrow-spectrum antibiotics, 6% knew how to transition from IV antibiotics to oral antibiotics, 12% knew of dosing and duration, and 14% understood the spectrum of activity of antibiotics. Forty-seven percent of respondents think hand hygiene is unimportant. Medical students in Zambia expressed a good level of knowledge, but low levels of training and confidence regarding antimicrobial prescribing practices and resistance. Our study highlights training gaps and possible areas of intervention in the medical school curriculum.

Kinesiology and Physical Education: A Curriculum (Dis)Alignment Perspective

This conceptual article focuses on the curriculum disalignment issue that seems to be a contributor to the marginalization of K–12 physical education. Through a brief historical review of events, especially the 1991 Critical Crossroads conference, the article explores and explains reasons that the future of K–12 physical education should rely on developing health-centered, concept-based curricula consistent with kinesiology science. In a major section, the article documents a 20-year effort and findings of curriculum intervention research in elementary, middle, and high schools to advocate and deliberate the need for a curriculum reform that should center on aligning physical education with kinesiology science. Implications of the kinesiology–physical education curriculum alignment to student learning are emphasized, and a paradigm change perspective to curriculum reform is discussed as a path to revitalize K–12 physical education.

Reflections on integrating environmental social work methods of intervention in Zimbabwean social work curriculum

Undeniably, natural climatic shocks, poverty and environmental degradation have become intractable challenges Zimbabwe grapples with. Worthwhile to note is how to overcome enduring precarity for predominantly rural and peri-urban communities the enduring livelihood strategy has been to harness natural resources. For instance, Zimbabwe hosts some of the most important biodiversity hotspots in the world and is home to over 5,930 species of plants and over 1,360 animals. Forests currently cover around 45% of the country’s total land area, but deforestation is an increasingly pressing issue, resulting in forests disappearing at a frightening rate. Given how developmental social work has become important thinking in social work scholarly discourses, its domains like environmental social work have become important for mainstreaming in social work training curricula and fieldwork. Based on review of secondary literature, the objective of this article is to offer pathways by which social worker educators can embed critical perspectives of environmental social work methods of interventions. This would be embedded in the curriculum components including research and fieldwork practicum. This can aid mainstreaming of environmental social work themes, debates and strategies in delivering courses centred on community, rural and social development. The article concludes by discussing possible constraints and opportunities in galvanising environmental social work visibility in the Zimbabwean and African social work curricula.
 How to reference using ASWNet style:
 Nhapi, T. (2023). Reflections on integrating environmental social work methods of intervention in Zimbabwean social work curriculum. African Journal of Social Work, 13(2), 118-126. https://dx.doi.org/10.4314/ajsw.v13i2.8
 Visit journal website: https://ajsw.africasocialwork.net

Language Skills' Acquisition on the Reading Comprehension and Performance in English Core Subject of Senior High School (TVL) Students in Modular Modality of Learning: Basis for Curriculum Intervention

English as a subject in the Senior High School Curriculum has always been the center for assessment and evaluation activities to measure its cognitive and academic impact to the students. Like many other language researches done in the past, this paper aims to investigate the reading comprehension and academic performance of Senior High students in English Core Subject such as the Reading and Writing. Further, it investigates the level of Language Skills Acquisition using the theory established by DeKeyser in 2007. The respondents of this study are the students of Technical-Vocational and Livelihood Strand or TVL. The data gathered were interpreted through statistical methods in order to explain the relationships and differences of these factors in the learning process of the students during the advent of Covid-19 pandemic.

Developing medical professionalism in care of gender nonconforming patients: Reflections of second-year medical students after a curricular experience with gender nonconforming people and allies

Introduction Negative healthcare experiences persist for gender nonconforming individuals. Clinician-related factors, including lack of comfort with gender nonconforming persons and unexamined personal biases, present barriers to equitable and affirming healthcare. We explored the effects of contact with gender nonconforming individuals in preclinical medical education through a structured curricular intervention designed to build medical and humanistic knowledge and stimulate the development of medical professionalism surrounding the care of gender nonconforming individuals. Methods A curricular module (didactic prework, time-synchronous online panel discussion, and post-event written reflection) was implemented in a second-year preclinical course in a large multi-campus Midwestern medical school. The module was based on pedagogical foundations of contact theory and reflective writing. Post-event written reflections were investigated using thematic analysis. Results Analysis of 355 written reflections revealed three major themes (moments of insight, topics of confusion, connections to professional identity formation) and eight sub-themes. The findings demonstrated emerging gender professionalism and the importance of contact in professional development. Discussion Contact with gender nonconforming people and the use of written reflections can encourage self-examination and foster professional identity formation among preclinical medical students. Modeling gender-affirming approaches may help counteract negative cultural messages about gender nonconforming people, aiding development of inclusive future physicians.

Experiences of burnout, anxiety, and empathy among health profession students in Qatar University during the COVID-19 pandemic: a cross-sectional study

BackgroundThe prevalence of burnout and anxiety is constantly increasing among health profession students worldwide. This study evaluates the prevalence of burnout and its relationship to anxiety and empathy during the COVID-19 pandemic among health profession students in the main governmental institution in Doha, Qatar using validated instruments.MethodsA cross-sectional survey of health profession students using validated instruments was employed. The Maslach Burnout Inventory-General Students Survey (MBI-GS(S)) to measure burnout; The Generalized Anxiety Disorder (GAD-7) to measure anxiety; and Interpersonal Reactivity Index (IRI) to measure empathy were utilized. Descriptive statistics and multivariable linear regression were used.ResultsOf the 1268 eligible students, 272 (21.5%) completed the online survey. Burnout was found to be prevalent amongst the students. The mean scores for the MBI-GS(S) subscales of emotional exhaustion, cynicism, and professional efficacy were 4.07, 2.63, and 3.97, respectively. Anxiety was found to be a strong predictor for burnout and burnout was positively associated with empathy.ConclusionsFindings from this study demonstrated relationships between health profession students’ burnout, anxiety, and empathy. These findings might have an impact on the development of curriculum interventions to enhance student well-being. More burnout awareness and management programs that cater to the specific needs of health profession students are needed. Furthermore, findings of this study may have implications for future educational interventions during times of crisis or how this can be used to improve student experiences in normal times.

An integrated approach to address diabetes in the context of food insecurity: Delivering health study protocol

BackgroundDiabetes self-management education and support (DSMES) interventions among food insecure individuals with type 2 diabetes (T2D) have found modest improvements in nutrition and health outcomes but are limited by barriers to attendance and retention. This study applies a community-based participatory research approach, engaging community members at all levels of intervention planning, development, implementation, and dissemination, to deliver a plain-language DSMES curriculum to food insecure community members with T2D. MethodsThis is a single-arm, pre-post design assessing the efficacy of a 12-week home-delivered DSMES curriculum and T2D-appropriate food box intervention to improve the nutrition and health outcomes of food insecure individuals with T2D. The intervention consists of a weekly food box delivery and handout with video links on key DSMES topics, developed and refined using community advisor feedback. Up to 100 English-, Spanish-, or Marshallese-speaking adult participants with T2D (HbA1c ≥ 7%) and food insecurity are being recruited from food pantries in northwest Arkansas. Data is collected at pre-intervention and immediately post-intervention. The primary study outcome is change in HbA1c. Secondary measures include diet quality (Healthy Eating Index-2015, calculated from 3 24-h dietary recall interviews via phone), body mass index, blood pressure, skin carotenoids, food security, T2D self-management behaviors, T2D self-efficacy, and T2D-related distress. ResultsRecruitment began in August 2021 and enrollment is anticipated to be complete in March 2023. ConclusionFindings from this study will provide a rich understanding of diabetes-related health outcomes and dietary patterns of individuals with food insecurity and T2D and inform future food-focused DSMES interventions in this setting.

Role-Specific Curricular Needs for Identification and Management of Immune-Related Adverse Events.

Immune checkpoint inhibitors (ICIs) activate the immune system against cancer and have become standard of care for many cancers. With increased ICI use, their toxicitiesknown as immune-related adverse events (irAEs) are becoming more common, but it is unclear how prepared relevant clinicians feel to diagnose and treat irAEs. The objective of this study was to assess irAE knowledge, confidence, and experience among generalists and oncology clinicians to guide future curricular interventions related to irAEs. A 25-item survey with questions assessing knowledge, experience level, confidence, and resource utilization regarding irAE diagnosis and management was sent to University of Chicago-affiliated(UChicago) internal medicine residents and hospitalists (inpatient irAE management)along with UChicago oncology fellows, attendings, nurse practitioners (NPs), andphysician assistants (PAs) (inpatient and outpatient) as well as Chicago community oncologists (outpatient) in June 2022. Overall response rate was 37% (171/467). Knowledge scores averaged below 70% for all clinicians. "No idea" responses were most common with knowledge questions on steroid-sparing agent use and ICI use for patients with preexisting autoimmune disease. IrAE experience correlated with higher knowledge for oncology attendings (p = 0.015) and hematology/oncology NPs/PAs (p = 0.031). IrAE experience correlated with higher confidence for residents (p = 0.026), oncology fellows (p = 0.047), and hematology/oncology NPs/PAs (p = 0.042). Most commonly utilized resources were colleagues and UpToDate, and most clinicians were very likely to use online resources in the future. Knowledge and confidence gaps exist, and they were somewhat mitigated by experience. Future irAE curricula can fill these needs through online role-specific resources: irAE identification for generalists versus irAE identification and management for oncologists.

Student experience and digital storytelling: Integrating the authentic interaction of students work, life, play and learning into the co-design of university teaching practices

Designing strategic pedagogical change through the lens of a student experience that is yet to be experienced offers a critical frame for embedding the impacts of transition, uncertainty, belonging and the complexity of the student journey into the co-design of teaching and learning. A digital storytelling approach extends the notion of the student experience beyond the singular and metricised descriptions common in online student satisfaction survey instruments into a rhizomatic, resonant living community that resides in the intersecting spaces of work, life, play and learning. This paper describes an ethnographic-like model of collecting and evaluating the student experience through a semi-structured digital storytelling methodology that supports both co-design and cogenerative dialogue as a form of curriculum enhancement. The paper outlines how the Student Experience Digital Storytelling model was iteratively designed, deployed, and then evaluated through participatory action research-informed case studies at the University of Sydney Business School (Australia) and the London School of Economics and Political Science (United Kingdom) that embedded the student experience into the co-design of curriculum and assessment interventions.

Medical student perspectives on substance misuse education in the medical undergraduate programme: a grounded theory approach

BackgroundSubstance misuse teaching within the undergraduate medical curriculum has been underrepresented compared to more traditional medical topics. In response several national curriculum reviews such as the most recent UK department of health initiative (DOH) have identified deficiencies in substance misuse education and have suggested curriculum interventions for local faculties to implement. The student perspective however has largely been muted during this process and this study aims to explore this using a constructivist grounded theory approach.MethodsEleven final year and intercalating medical students across three separate focus groups participated in this study over a three-month period commencing from March 2018. Time between the audio recorded focus groups allowed for a parallel process of data collection and analysis into more focussed codes and categories to occur, consistent with the grounded theory approach. The qualitative study took place in a single medical school in the UK.ResultsMedical students had a common consensus that substance misuse education was an underperforming subject in their curriculum, from limited teaching hours to curriculum design and organisational problems. Students identified an alternative curriculum is required to not only prepare students for their future clinical duties but also their own personal lives. Students highlighted this proximity to a ‘dangerous world’ where exposure to substance misuse risks were faced daily. This exposure also provided a source of informal learning experiences which students deemed as being potentially unbalanced and even dangerous. Students also identified unique barriers to curriculum change with reference to a lack of openness due to the impacts of disclosure in substance misuse.ConclusionLarge scale curriculum initiatives appear to correspond to the student voice obtained in this study, providing backing for the implementation of a co-ordinated substance misuse curriculum within medical schools. The student voice however provides an alternative lens by outlining how substance misuse pervades into students’ lives and how informal learning is a largely underestimated hidden source of learning with more dangers than benefits. This together with the identification of further barriers to curriculum change, provide space for medical faculties to incorporate and work with students to facilitate local level curriculum changes relating to substance misuse education.

Leadership Training in Undergraduate Medical Education: A Systematic Review

Background: This review seeks to characterize existing curricular interventions implemented to develop leadership skills in undergraduate medical students at LCME-accredited medical schools and elucidate best practices for leadership curriculum development. Methods: PRISMA guidelines were used to guide the review. Comprehensive literature searches of five databases retrieved peer-reviewed journal articles with empirical data published in English. Two phases of screening were conducted to identify studies describing leadership development curricular interventions, followed by data extraction and synthesis. Results: Comprehensive literature searching and hand searching identified 977 articles potentially eligible for inclusion, with a final set of 16 articles selected for the review. A majority of the leadership development programs targeted preclinical students, while others spanned the entire curriculum. "Mixed settings," including both classroom and clinical and community components were common. There was a wide range of cohort sizes spanning from over 100 students to fewer than 10. Using the competencies defined by Mangrulkar et al, we determined that all of the programs described leadership skills development, including conflict management and emotional intelligence. Out of the 16 selected studies, curricula that emphasized the development of skills were evidence-based medicine and practice, and 6 curricula targeted interprofessionalism. Conclusions: Leadership development needs to be standardized in undergraduate medical education, ideally using a competency-based framework to develop these standards. Longitudinal programs that had a didactic and project-based component received consistently high quality and effectiveness scores, as did programs with smaller cohort sizes that received more consistent mentorship and monetary investment from institutions.

Effects of a Responsive Parenting Intervention Among Black Families on Infant Sleep

Black individuals in the US experience sleep disparities beginning in infancy and continuing throughout the lifespan, suggesting early interventions are needed to improve sleep. To investigate whether a responsive parenting (RP) intervention for Black mothers improves infant sleep and increases responsive sleep parenting practices. This is a post hoc secondary analysis of the Sleep SAAF (Strong African American Families) study, a randomized clinical trial comparing an RP intervention with a safety control condition over the first 16 weeks post partum. Data were collected between spring 2018 and summer 2021. Families were recruited from the mother-infant nursery at Augusta University Medical Center, Augusta, Georgia, and completed home visits at 1, 3, 8, and 16 weeks post partum. Primiparous Black mother-infant dyads were screened for eligibility using medical records. Results were analyzed on an intention-to-treat model. Data were analyzed from March 2022 to January 2023. The RP intervention curriculum focused on infant sleep, soothing and crying, and feeding. The control group received a safety intervention. Community research associates delivered the interventions during home visits at 3 and 8 weeks post partum. The primary end point was infant sleep duration at 16 weeks. Mothers reported on bedtime routine and sleep behaviors, infant sleep duration, and nighttime waking and feeding at 8 and 16 weeks post partum using questionnaires. A total of 212 Black mothers (mean [SD] age, 22.7 [4.5] years) were randomized, including 208 mothers (98.6%) who identified as non-Hispanic and 3 mothers (1.4%) who identified as Hispanic; 108 mothers were randomized to the RP group and 104 mothers were randomized to the control group. At 16 weeks post partum, infants in the RP group had longer reported nighttime sleep duration (mean difference, 40 [95% CI, 3 to 77] minutes), longer total sleep duration (mean difference, 73 [95% CI, 14 to 131] minutes), fewer nighttime wakings (mean difference, -0.4 [95% CI, -0.6 to -0.1] wakings), and greater likelihood of meeting guidelines of at least 12 hours of total sleep per day (risk ratio [RR], 1.4 [95% CI, 95% CI, 1.1 to 1.8]) than controls. Relative to controls, mothers in the RP group more frequently reported engaging in some RP practices, including giving the baby a few minutes to fall back asleep on their own (RR, 1.6 [95% CI, 1.0 to 2.6]) and being less likely to feed their baby as the last activity before bed (RR, 0.5 [95% CI, 0.3 to 0.8]). This secondary analysis of a randomized clinical trial found that an RP intervention for Black families improved infant sleep and increased some responsive sleep parenting practices. ClinicalTrials.gov Identifier: NCT03505203.

Exploring Students' Perceptions of the teaching pedagogies: in developing Communication Skills among Multilingual Undergraduates

The focus of the research work is to report on research from the curriculum interventions that explored whether undergraduate university students are proficient enough in communication skills for social and academic purposes, moreover, the perception of students about their communication skills is studied and factors are identified that may have contributed towards their strong or poor communications skills in the English language. The study includes 300 undergraduate students, from four different programs and institutes. A survey having a questionnaire of 52 items is used and information obtained is sorted out with the help of SPSS in order to get a full and detailed picture of various patterns and themes. The findings of the survey establish that students having a better language learning experience at the school level perform better in their communication skills course at the university level.

A Novel Serious Illness Communication Curriculum Improves Neurology Residents' Confidence and Skills.

Background and Purpose: Competency in serious illness communication is mandated by the Accreditation Council of Graduate Medical Education. Previous efforts to teach communication skills have been hampered by intensive time requirements. In this study, we developed and evaluated a brief goals-of-care communication curriculum for neurology residents. Methods: We developed and implemented a two-part curriculum based on themes identified from a needs assessment: (1) fundamental physician-patient communication skills; and (2) counseling surrogate decision makers and providing neuroprognostication. We used a three-pronged pre-post study design to evaluate the impact of the curriculum: resident self-assessment surveys, direct observations of resident-patient interactions, and patient perception surveys using the Communication Assessment Tool. Results: Residents reported a significant increase in mean scores [standard deviation] of confidence practicing fundamental communication skills, such as offering opportunities for emotion (3.84 [0.9] vs. 4.54 [0.6], p = 0.002), and goals-of-care communication skills, such as using triggers for serious conversations (2.65 [0.7] vs. 3.29 [0.5], p = 0.004). Observed resident-patient interactions showed significant improvement in fundamental communication skills, such as involving the patient in decision making (1.89 [0.6] vs. 4.0 [0.9], p < 0.001). There was no significant impact on patient perception of resident communication skills in the three months following the intervention. Conclusions: A brief, learner-centered curricular intervention improved neurology residents' confidence in serious illness communication and improved their skills as judged by trained observers.

Healthy and Equitable Interpersonal Relationships, Health Inequalities and Socio-Educational Interventions: A Conceptual Framework for Action.

Interpersonal relationships undoubtedly have a bidirectional connection with the health of individuals and communities. Relational models based on equity contribute to well-being, while asymmetrical relationships based on hierarchies and differences of power negatively impact mental, physical, and social health. A conceptual framework for understanding the determinants of interpersonal relational models was developed. Structural determinants were identified as the combined action of systems of oppression, the socio-historical context that normalizes violence, and social stratification and segregation, consequences which included inequitable access to power, resources, and opportunities. Intermediate determinants include individual, psychosocial, behavioral, and community aspects. Structural and intermediate determinants impact health and health inequalities through multiple relational patterns that are simultaneously established and sustained by individuals and communities. The health impact of inequitable relational patterns includes: Reduced self-esteem; anxiety, stress, and depression; acceptance of violence; physical and sexual harm; suicide; and murder. This conceptual framework allows for the modification of relational models by influencing structural and intermediate determinants. Six areas of intervention have been identified: educative policies, school governance, physical and symbolic space, school curriculum, school-community relations, and socio-educative interventions to promote healthy and equitable relationships. Healthy and equitable relationships are associated with improved subjective well-being, health status and protection from violence. Socio-educational interventions that consider the elements of this conceptual framework may be effective in promoting healthy and equitable relational models.

Adapting and Developing A Diabetes Prevention Intervention Programme for South Africa: Curriculum and Tools

The South African Diabetes Prevention Programme (SA-DPP) is a lifestyle intervention targeting individuals at high risk of developing type 2 diabetes mellitus (T2DM). In this paper we describe the mixed-method staged approach that was used to develop and refine the SA-DPP intervention curriculum and the appropriate tools for local resource-poor communities. During the preparation phase, existing evidence on similar DPP interventions was reviewed, focus group discussions with individuals from the target population were conducted as part of a needs assessment, and experts were consulted. The curriculum booklet, a participant workbook and facilitator workbook were developed, and the content was evaluated by experts in the field. The design and layout of the booklet and workbooks needed to be culturally and contextually appropriate. The printed material was evaluated for readability and acceptability by participants of the target population; based on their feedback, the design and layout were refined and the printed material was translated. The suitability of the intervention was tested in a pilot study; based on feedback from the participants and facilitator, the curriculum was revised where needed and finalised. Through this process a context specific intervention and printed materials were developed. A complete evaluation of this culturally relevant model for T2DM prevention in South Africa is pending.

What Makes Study Abroad Transformative? Comparing Linguistic and Cultural Contacts and Learning Outcomes in Virtual vs In-Person Contexts

To what extent can the transformative power and language learning affordances provided by the study abroad experience be virtualized? The large-scale shift away from on-site study abroad to online learning in 2020-2021, caused by the COVID pandemic, has made it possible to compare data for in-person immersion learning versus digitally mediated forms of direct instruction and second language (L2) community engagement of otherwise similarly prepared L2 learner cohorts. The present study compares measured proficiency outcomes, as well as other performance-based data of late-adolescent and young adult U.S. participants in a group of federally sponsored overseas intensive immersion study programs for Arabic, Chinese, and Russian operating abroad for the period 2017-2019 and as virtual programs in 2020-2021 (in-person N=1388 and virtual N=770). Program data for early-stage learners, mid-level learners, and advanced learners are analyzed separately by target language, initial proficiency levels, and program durations. As a result of the COVID pandemic, all programs shifted from in-person format to virtual instruction, provided by the existing overseas partner faculties, who adapted core curricula, group instruction, direct enrollment courses and tutorials for use in both synchronous and asynchronous forms of online instruction. Similarly, organization of homestay visits, internship programs and cultural programming was also shifted to virtual format. Given the importance of language contact and L2 interactions, this study provides comparisons of both aggregate and activity-specific L2 time-on-task levels for both cohorts, documenting comparable levels of instructional time available within the two formats (18 hours/week), but less than half the available hours to the virtual student for informal L2 contact and community engagement activities. Comparisons of the speaking proficiency outcomes by language and training levels revealed a relatively consistent gap in mean gain levels across languages, with participants in the virtual groups attaining on average one proficiency sub-level lower in speaking gains than their respective face-to-face counterparts. Comparisons of reading, listening, and writing outcomes, however, showed smaller differences, sometimes none at all. Intercultural Development Index (IDI) and other data related to participants’ cultural competencies, including cultural referencing, self-presentation (Identity Competence), socio-pragmatic strategy selection, lexical and collocational choices, and other markers were observed generally to fall short of the standards set in previous years by students enrolled in the in-person versions of the same programs. Finally, the study takes note of curricular and technological interventions introduced during the COVID period which have been recommended for adoption in the new cycle of in-person programs in 2022-2023 and beyond.

Lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI+) healthcare in Singapore: perspectives of non-governmental organisations and clinical year medical students

ABSTRACT Purpose International studies document that lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI+) patients face significant health disparities. Studies exploring the attitudes, knowledge, preparedness and comfort levels of healthcare students towards LGBTQI+ health have been conducted in the United States, United Kingdom and Malaysia. This study aims to investigate stigma in healthcare for LGBTQI+ patients in Singapore, and possible upstream factors within medical education. Methods This mixed-methods study adopts a convergent parallel design. The Health Stigma and Discrimination Framework was referenced to devise in-depth interviews with representatives from 13 LGBTQI-affirming non-governmental organisations, analysed through thematic analysis. 320 clinical medical students were surveyed about attitudes, knowledge, comfort, preparedness, and perceived importance of/towards LGBTQI+ health, analysed via descriptive statistics and multivariate regression. Results Prevailing stigma in Singaporean society against LGBTQI+ individuals is exacerbated in healthcare settings. Doctors were cited as unfamiliar or uncomfortable with LGBTQI+ health, possibly from lack of training. Among medical students surveyed, the median composite attitudes, comfort and preparedness index was 3.30 (Interquartile Range (IQR) = 0.50), 3.17 (IQR = 0.83), 2.50 (IQR = 1.00) respectively. Only 12.19% of students answered all 11 true-false questions about LGBTQI+ health correctly. Conclusion Medical students in Singapore have scored sub-optimally in their knowledge and preparedness towards LGBTQI+ health, while interpersonal and structural stigma in healthcare towards LGBTQI+ people in Singapore negatively affects health and wellbeing. These findings are an impetus to improve medical training in this area. High scores among medical students in attitudes, comfort and perceived importance of LGBTQI+ topics demonstrate that there is space for LGBTQI+ health in the local medical education curriculum. Curricular interventions can prioritise content knowledge, communication skills and sensitivity.

Curricular Interventions in Medical Schools: Maximizing Community Engagement Through Communities of Practice.

This article explains the importance of a communities of practice (CoP) model for continually aligning medical education and clinical transformation with contemporary health issues. It describes the evolution and advantages of using CoP as a model for transforming medical education and clinical practice and applies the CoP methodology to addressing the changing needs of socially vulnerable populations (LGBTQ [lesbian, gay, bisexual, transgender, and queer/questioning], persons experiencing homelessness, and migrant farm workers). In conclusion, this article describes CoP-led activities, achievements, and value creation in medical education by the National Center for Medical Education Development and Research established at the Meharry Medical College.

Safe and Sound: An Improvisational Theater-Based Curriculum and Behavioral Intervention to Address Violence in the Emergency Department

Background: Emergency department (ED) workplace violence has become increasingly prevalent in the United States, warranting the development of legislation, policy, and advocacy to protect health care workers. Solutions to address ED violence remain limited, and staff-oriented trainings often exist as short, one-time didactic sessions, which are not practical nor often applicable to the ED setting. There is a paucity of evidence-based interventions that incorporate behavioral-based training to adequately prepare staff for the complicated, multifactorial presentation of violence in the ED. Objective: This pilot study sought to assess the feasibility of an improvisational theater–based, simulation intervention for health care professionals to address ED violence. Methods: A longitudinal curriculum for ED violence was developed in collaboration with a committee of emergency medicine (EM) faculty, EM simulation experts, hospital security and police personnel, professional theater and improvisational performers, resident physicians, and medical students. This pilot intervention was tailored to new EM residents (n = 25) at a large, urban, academic medical center. Sessions were led by facilitators trained in group facilitation, simulation, and improvisation. Results: Participants felt the curriculum was helpful (82.6%), engaging (91.3%), applicable (73.9%), and enjoyable (82.6%). Participation primarily by residents identifying as female and people of color suggested the efficacy of creative expression and nontraditional modalities in engaging diverse learners. Ninety-five percent of participants expressed interest in future sessions. Conclusions: A multidisciplinary workplace violence intervention leveraging principles of improvisational theater, health equity, organizational psychology, and EM simulation may prove useful in preparing health care professionals for violence in the ED.